In this assessment you will continue as a member of the Chief Compliance Officer’s team. Recently, an incorrect
billing practice known as upcoding has been discovered. Upcoding is a common area for fraud and abuse, and the
recent incident has become an area of major focus for the Chief Compliance Officer.
The Chief Compliance Officer has tasked you with researching and making evidence-based recommendations about
how to identify and address this incorrect billing practice. Your recommendations will be considered for possible
inclusion in future policy and procedure content.
The Chief Compliance Officer has stressed with you the importance of incorporating evidence-based
recommendations. This individual is specifically interested in the Office of the Inspector General’s position on
upcoding, any relevant case precedents, and any available resources for health care organizations. You know from
experience that the workplace brief will need to include substantiation of all facts and recommendations from
authoritative sources. The team leader has asked you cover all of the following headings in your brief:
Major Categories of Health Care Fraud and Abuse (2 pages)
Describe the major categories of health care fraud and abuse.
Be sure to include the billing practice known as upcoding.
Five Health Care Fraud and Abuse Laws (3 pages)
Provide a synopsis of five laws relating to health care fraud and abuse.
Include the rationale for why you selected the laws you did.
Upcoding and the Law (2–4 pages)
Explain in detail one law pertaining to upcoding.
Be sure to explain how the law specifically applies to upcoding.
Provide an actual example of upcoding.
Select your example from your suggested resources, from research you conducted on the topic, or
from your professional experience. If your example stems from your professional experience, please be
sure to protect individual and organizational identities.
Identifying and Addressing Upcoding in Health Care (2–4 pages)
Propose a list of evidence-based recommendations to identify and address upcoding in the health care
Be sure to consider in your recommendations what the Office of Inspector General has to say about
identifying and addressing upcoding.
Tip: Visit these websites:
Centers for Medicare and Medicaid Services. (2017). Avoiding medicare fraud and abuse: A
roadmap for physicians. Retrieved from https://www.cms.gov/Outreach-and-
United States Department of Health and Human Services & Office of Inspector General.
(n.d.). Compliance education materials: Compliance 101. Retrieved from
Written communication: Use the linked Identifying and Addressing Upcoding Template [DOCX]. Ensure your
workplace brief is clear, succinct, well-organized, and generally free of errors in grammar, punctuation, and
Length: Approximately 8–10 double-spaced content pages in Times New Roman, 12-point font, including the
Title page: Develop a descriptive title of approximately 5–15 words. It should stir interest, yet
maintain professional decorum. Ensure that your title page conforms to current APA format.
References: Include a minimum of 6 current (within the past 5 years), authoritative citations in current APA
format. Include a separate reference page that also conforms to APA guidelines.
APA format: Use current APA style and formatting. Indent the first sentence of all new paragraphs.
Font: Times New Roman, 12-point.
Scoring guide: Review the scoring guide for this assessment so that you understand how your faculty
member is going to evaluate your work.
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write a workplace brief 8 10 double spaced pages of evidence based recommendations to identify and address upcoding an incorrect health care billing practice include a description of the major categories of health care fraud and abuse and the laws des was first posted on June 30, 2020 at 1:47 am.
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